Five Important Functional Medicine Tests for Fertility

My training in nutrition is based on the approach of Functional Medicine (FM). FM is a new branch of medicine which is becoming more and more popular, because it looks at the body as a whole, not as different organs or systems. Just as the Functional Medicine model looks at a patient as a whole person, it also does not aim to cure symptoms, but it strives to find the root cause of health imbalances, through an individualised, patient-centred and science-backed method, which shows patients how to regain health and vitality.

The aim of this approach is also to shine a light on unanswered questions.

One of the examples that is often given to explain this is the one of depression. This may often seem like a symptom of the mind but in fact, it may originate from different imbalances in the body such as the thyroid, nutritional deficiencies, gut health or even a pre-diabetic state.

In the same vein, struggling with fertility or particular hormonal conditions (e.g. PCOS) can be symptoms of an imbalance, but what is their root cause?

That’s when the investigative work starts.

One of the ways Functional-Medicine-trained nutrition practitioners, like me, carry out these investigations is via a certain amount of targeted testing, prioritised with the client’s full medical history in mind.

Let’s dive into the most useful tests, when it comes to fertility.

Thyroid Testing

The thyroid gland is so important for many aspects of our health, because the hormones it produces are needed by every single cell of our body. It’s no surprise that having too much or too little thyroid hormones may be linked to problems with fertility, miscarriage as well as issues with the foetus development. Making sure your thyroid is in order is an important insurance policy for your fertility and future pregnancy because thyroid hormones are essential for conception and maintaining a healthy pregnancy. Unfortunately, standard thyroid tests will often include only limited markers (namely TSH) and offer very wide ranges for them. In other words, you may have been told that your thyroid hormones are in range but they may in fact not be optimal for fertility. Even worse, you may actually experience thyroid related symptoms and not be aware of them. In fact, an autoimmune form of hypothyroidism called Hashimoto’s, which counts for 80% of hypothyroid conditions, often goes undiagnosed.

The functional medicine approach with the thyroid is to look at a full panel of markers, which not only includes your thyroid hormones’ production, but also any thyroid related antibodies which may be having an impact on this major gland and your immune resilience, which is also discussed below with Vitamin D.

Vitamin D Testing

I am sure you have by now heard of the importance of Vitamin D with regards to its immune protective effects. Vitamin D is also very crucial for fertility and a healthy pregnancy. Unfortunately, however, Vitamin D deficiency is very common. This is reflected also in the fertility community with studies pointing at lower pregnancy rates in women undergoing ART who are deficient in Vitamin D (2012). Vitamin D levels are super important because this vitamin, which in fact acts more like a hormone, can have an impact on the immune system during preconception for example by regulating Natural Killer cells and auto-immunity (2012. 2003), which in turns can influence the ability to maintain a pregnancy and other factors such as endometrial thickness (2016). Fertility in men is also influenced by their Vitamin D Status. Since we get Vitamin D mostly from sun exposure in summer months, in the UK and other Northern Hemisphere countries, doctors recommend we take a maintenance dose of Vitamin D in the winter months. However, this may be insufficient in the case of deficiency or suboptimal levels, hence the importance of knowing your exact levels. “Test don’t guess” is a phrase often heard in the Functional Medicine world. Exactly because it’s the best way to adjust supplementation recommendations.

Nutrition based testing

In-depth nutrition testing could include testing the above components, i.e. thyroid and Vtamin D, and will provide a full picture of other important factors that affect fertility and hormone balance. This is also quite crucial when it comes to really personalising your supplements, yes even your fertility or prenatal multi, starting from the adequate levels of folate, b12 and iron for your own situation.

Another important aspect of nutrition-based testing is to review your metabolic state and whether there may be any issues to do with blood sugar management.

Blood sugar dysregulation is often at the foundation of hormonal imbalances, weight gain, tiredness, fatigue and low moods as well as other metabolic conditions such as high blood pressure and high cholesterol. No wonder this is crucial to investigate and correct during the preconception period, in order to also minimise the chances of gestational diabetes during pregnancy and/or the risk of developing Type 2 diabetes later in life. Women with PCOS, in particular, often seem to present with insulin resistance, AKA high insulin, in some tissues of the body, which is often in response to increased blood sugar levels.

Excess insulin is caused by repeated/chronic high blood sugar levels, often due – but not always – to the consumption of highly refined carbs in our diet. This can hinder ovulation by increasing male hormones (also called androgens) and creating an imbalance in all the other hormones.

A common marker for blood sugar balance called HbA1C is often used by primary care doctors to look at your historic blood sugar levels for the past 3 months. However, often this is not a sufficient marker and other markers such as fasting glucose and also cholesterol and kidney health may be more indicative of what is really going on in terms of how your body responds to blood sugar and corresponding insulin.

Stress Hormones

It is very likely that during your TTC journey, you would have been offered an assessment of your sex hormones. Whilst this can be very useful, provided that the tests were taken at the correct time of your cycle, it does not always solve all the puzzles around fertility. Other types of hormones, as we have seen for the thyroid, are often neglected. This is the case for our adrenal hormones, which regulate our stress response. One of the adrenal hormones that are typically associated with stress is cortisol. Whilst crucial in so many pathways of our body, continuously elevated cortisol in response to chronic stress has been shown to interfere with a cascade of lots of other hormones, including, and not limited to, our sex hormones and the thyroid. Are you starting to see how everything in our body is interlinked? Testing cortisol, which can also be added alongside sex hormones, is pretty easily done through saliva and blood testing, even through hair now, and can be beneficial to motivate you in finding ways to adjust your lifestyle or learning to tone down the response to daily stressors through simple consistent lifestyle modifications.

Microbiome testing

Last but not least, did you know that we are more bacteria than humans? The discovery of the microbiome in the last 10 years and its effects on human health has revolutionised science. The microbiome is an umbrella term that indicates all the different bacterial species living on us and within us and it’s estimated that there are more than 100 trillion bacteria in our microbiome, 3 times the cells of our body! The body system with the most abundant population of bacterial species is our gut. Our gut bacteria regulate our digestion and absorption of nutrients, but also our mood, our immune response, our blood sugar response and sensitivity to the foods we ingest, our elimination of toxins and of extra hormones etc. Moreover, the gut microbiome is closely linked to the reproductive microbiome, i.e. the female vaginal microbiome. Although, the number of species in the reproductive microbiome is not as diverse as the one in the gut, any introduction of pathogens or imbalances in these two microbiomes (also termed dysbiosis) can have a similar detrimental impact to both our health and our ability to conceive.

When it comes to fertility, testing at least the vaginal microbiome can be really helpful to start digging deeper into the reasons for possible issues with conception and can provide many clues also into any impact on sperm health.

That’s why I use these tests in my nutrition practice in most cases and have decided to create my testing programs called “Test ‘n Thrive” where many of these tests are already included.

However, some of these tests can be requested, as long as there is a justification in terms of symptoms with your doctor and this is also another area I support my clients with when we work together.

If you’re curious about any of these tests and would like to hear more about how I work with them in my 1:1 nutrition programs please do feel free to reach out and book a free chat with me, as I believe more and more people should be aware that these tests are available and can be super helpful in creating a full picture of your health and provide many clues to your fertility puzzle.